Hi All,

After a phone call to my Atty, I received my 22 page report via email...still have yet to receive the hard copy in the mail...

I'm going to bullet point key points, it's easier for me and hopefully for you as well, to follow along...

One thing I would like to state before I do so however, is that I WISH I had been somehow warned that this was going to be a HIGHLY EMOTIONAL experience for me...it's so very different to read about yourself in a professionally written document...it's difficult for me to explain...I became VERY upset and have spiraled down symptom wise as a result...I'm cutting myself some slack though, it was a lot to comprehend...here goes....

1) I am not malingering or "faking" my injury or symptoms...I could've told them this...oh yes, that's right I DID...but no one listens...or has believed me.

2) My pre-morbid intelligence was "Above Average"...my current level of intelligence is "Below Average"...this was the "straw that broke the camel's back"...doesn't get more humbling than this....

3) I am "apparently" a "Suicide Risk"...seems as though I "overly downplayed my symptoms"...it is believed that I contemplated suicide at some point...I would like to say, for the record, this is untrue for several reasons...I have 3 beautiful Sons and there is NOT A CHANCE that I would EVER leave my children willfully...reading this made me very, very angry..more so than my baseline....(I'm going to start copying and pasting now....)

4)" In general, compared to expected levels of ability from the WTAR, Ms. * intellectual
test results are largely compromised. Aside from relatively intact processing speed, her overall
intelligence, verbal intellectual skills, performance intellectual functions, and working memory
are below expectations".

5) The frequency of Ms. * MMPI-2 high profile pair (2-3/3-2) is very rare in Normal
women, occurring in less than 1% of respondents. In contrast, her response profile is more
commonly found in women in medical settings (18.6%), in female personal injury litigants
(7.6%>), and in females with mild TBI (7.9%). There is a relative lack of clarity in Ms. *
MMPI-2 profile, suggesting that her scale elevations could change if/when she is retested with
this instrument.

6)Ms. * expected level of premorbid functioning would likely fall in the High
Average range. Compared to this level of capability, current areas of intact functioning
are limited to sensory/perceptual functions, motor skills, speech/language functions,
processing speed, and frontal/executive abilities. Additionally, Ms. * is socially
appropriate within a structured setting and appears to have a solid social support network.

7)On the other hand, areas of variable or deficient functioning include the following:
• Intelligence (e.g., reduced verbal and performance intellectual skills, etc.)
• Academic Abilities (i.e., intact reading and spelling, but impaired mathematics skills)
• Visuospatial Skills
• Learning/Memory (e.g., relatively intact verbal learning/memory, but impaired nonverbal
[visual] learning/memory functions, proneness to interference, etc.)
• Attention/Concentration (e.g., intact visual working memory, but reduced auditory working
memory, etc.)
The degree of Ms. * neurocognitive difficulties represents a clinically significant
change in functioning compared to premorbid levels of capability. Moreover, the
magnitude and scope of her deficits appears sufficient to impact many aspects of her
daily life at home and/or in a work environment.
There is a tendency for Ms. * to have greater difficulty with neurocognitive
functions associated with the non-language dominant (likely right) cerebral hemisphere.
However, neurological and/or neuroradiological assessment would be necessary to
determine the significance of this test pattern.

8)Nevertheless, given the Mild severity of Ms. * TBI and amount of time since the
incident in question (over 1.5 years), it is unlikely that the bulk of her current functional
impairments have a neuropathological cause. Moreover, her pattern of difficulties
associated with the non-language dominant (likely right) cerebral hemisphere is
inconsistent with the typical effects of MTBI.....????? I don't understand...

9)Regarding prognosis, the probability of additional spontaneous recovery is relatively
unlikely given the amount of time since the 7-21-10 incident. However, continued
treatment and use of compensatory strategies may assist Ms. * ability to cope with
and adjust to her post-accident limitations.

AND FINALLY....

RECOMMENDATIONS:
1. Ms. * should be provided with mental health treatment at this time. In
particular, consideration for psychiatric medication (e.g., anti-depressant
medication) may be appropriate, as recommended by her physician. Additionally,
involvement in supportive psychotherapy may be of benefit to augment her ability
to cope with changes in her post-accident functioning and to encourage
resumption of employment. Although she overtly denies suicidality, portions of
her current results suggest that this issue should be monitored closely by her
treatment providers and family.

2. Neurological follow-up appears appropriate for Ms. *. In addition to
ongoing monitoring of post-TBI issues, assistance with possible referrals may be
indicated. For example, referrals for pain management assistance and cognitive
rehabilitation might be appropriate.

3. The patient's learning/memory difficulties are significant at times and indicate
that she should utilize memory compensation strategies or tools whenever
possible. For example, use of a pocket calendar, GPS device, audiotaping, or
other electronic memory aides might be of benefit to Ms. *. If necessary, a
referral to a cognitive rehabilitation specialist may be appropriate for assistance
with these issues, particularly in the workplace.

4. Despite Ms. * aforementioned neurocognitive deficits, she demonstrates a
number of strengths including speech/language functions, processing speed, and
frontal/executive abilities. Although she currently does not appear capable of
resuming employment on a full-time basis, a gradual return to work on a part-time
basis appears indicated. It is recommended that Ms. * begin the process of
seeking employment on a part-time or 'per diem' basis. Assistance from a
vocational counselor may be of assistance during this process.

...I am very anxious for other's interpretation of the above. I know I have a very long road ahead of me...I am just praying that I can return to Nursing in SOME aspect...thoughts???

Julie,

Your report is interesting in both what is says about you but also, what is says about the NeuroPsychologist.

It appears to expose some biases of the NeuroPsychologist.

Before i go on, I suggest you edit out your last name and substitute Julie.

The MMPI-II may be showing elevated scales that are interpreted as depression/suicidality but would indicate organic brain injury if evaluated with the Cripe Neurological Symptoms criteria. This can be a common overlap diagnosis of the MMPI-II.

No. 5 indicates elevated scales in 2-3 with a lack of clarity as to the cause or diagnosis. This elevated pair needs to be evaluated using the Cripe Neurological Symptoms to focus on whether there is a statistical indication of organic injury. CNS shows how scales 1, 2, 3, and 8 can double indicate both organic and psychological deficits. Further analysis would be worthwhile.

No. 8 appears to be based on a common bias of considering the time since injury and projecting a level of neurological injury based on undocumented impact intensity or lack thereof. Research shows that it is impossible to impute neurological deficits based on an assumed impact intensity.

He states <9)Regarding prognosis, the probability of additional spontaneous recovery is relatively unlikely given the amount of time since the 7-21-10 incident. > This appears to be in conflict with No 8. Was the injury of a severity to cause permanent deficits or are the deficits of a non-organic basis? No. 9 appears to properly put a organic causation on the deficits. i.e. Non-pathological causes would suggest room for treatment and improvement with psychological and other treatments. Pathological/organic causes would suggest limited opportunity for spontaneous or other recovery or improvement.

The comments recommending use of memory compensation strategies and tools sounds appropriate but re-entry into the work-force prior to mastery of these strategies sounds premature. More pinpoint analysis of memory functions to allow a focus on compensation strategies could be warranted.

The deficits listed appear to cluster in a organic causation. Accepting the current level of deficits would allow the effort to develop compensation and work-around skills to be successful with proper support. A bit more specificity regarding individual deficits would have been helpful to allow focus on those defined deficits.

Julie, i hope I have not added more confusion and anxiety to this situation. As humbling as an NPA can be, it also allows an acceptance of deficits as organic rather than psychological/psychosomatic. The ability to confidently acknowledge that the symptoms are real and not imagined allows for a solid starting point to move forward.

My best to you.

Hi Julie,

I have nothing to add in the way of advice.

But I wanted to bip in and say that I'm so sorry to hear that you are sad after reading the results. I can't imagine what that's like.

I'm sending you a big hug through the ethernet cable - I hope it reaches you.

Hi Mark,

Thank you...thank you...and thank YOU I, in my own way, surmised a similiar opinion..however, I am not well versed with the different areas of testing as you are. I do agree that I detected "something" (bias)...my interpretation was one of a contradictory nature (I just had a hard time figuring that out...go figure)....and there in lies the "bulk" of my frustration!

On one hand you're saying..."OK, she's not malingering, these symptoms are MTBI"...but then it seems to say, "Well, depression and anxiety are exacerbating the symptoms..so let's treat her for that and everything else will fall in to place and she can go back to work...doing....something, but not what she use to do"....

You are correct that this is a good foundation in which to build upon. Knowing how you feel and finally receiving validation is more than humbling, I just haven't found "the best" word for that feeling yet...but it's big!!

Thank you also for the privacy tip...

May I add, that my 10 year old Son is silly with excitement knowing that I will be home AGAIN with him this Summer? He is my blessing, I swear...I could lay on the couch all day, but as long as I'm "here"...that's all that he wants...funny how life works sometimes huh?

I am very anxious to start treatment...and yes, I suppose I am in a deep state of denial...I'm still trying to figure out how I went from Full Time Mom, Full Time RN Manager, Fiance' and do it all girl running on empty with a SMILE...to this. All as a result of a few second incident. Wow. I continue to be at a loss for words....

Your support and that from each member of this forum means the world to me...thank you from the very bottom of my heart...truly.

Hello my LA friend

Thank you for the hug, I really REALLY needed just that!

The road before me is long, but I am grateful that I have a road to travel upon...as it continues to be said to me..."It could have been A LOT worse"...yes, and it could have NOT happened at all as well lol!!

I'm truly trying to take one day at a time...looks like this is a "bad spell" again for me, but I'm doing the best I can with what I have...what else is a girl to do, right?

We are having Summer like weather here in CT...that's a bonus...I love the warm weather and being able to open windows...makes naptime nicer listening to the birds too....

Thank you for your support...

Hi Julie,
I just wanted to add that I think you have an amazing attitude,.... and thank you for having the courage to share your report with us.
Best Wishes.

Julie,

Do you know about the Boston to New York Trolley Line from the late 1800' to early 1900's. The old road bed is still in place in many areas as it snakes across CT. There are also many other lines between the bigger cities and towns. It is a fabulous place to take long quiet walks.

You could have a great time walking with your son. In the 70's, I would ride bikes and motor bikes on it during the spring and summer, then walk it with my dad and brothers while hunting pheasant and squirrels during the fall.

The various trolley museums may have maps of the old road beds.

There is something special about the sounds of nature that settles the brain better than any recording.

btw, You can do you own cognitive therapy by working with your son on math tables and other mind math. Re-establishing the thinking patterns/skills for finite things like math are easiest. The more abstract thinking is often a struggle.

I have had to relearn mental math at least 4 times after previous concussions. It is done best when it is just a challenge and not a mandatory task. I would try to add up a few items to see if i could beat the check out girl with her register. It only works when you just have a few items and you know the prices. It is quite a thrill to beat the check out girl. (Don't mean to be sexist but the women/girls are the best so I just ignore the guys)

This can also be a fun challenge with your son.

Sudoku is too intense but Numbrix is a good challenge.

My best to you.

Hi Mark,

I'm not familiar with the Trolley lines, but now you've given me something to look in too However, I've been invited on various "hikes" with friends and have declined because I have this "fear" of getting lost...I got lost once at the mall with my oldest Son...could NOT remember where I parked my car and he wasn't paying attention...that turned in to a full blown panic attack for me...it wasn't fun....but now I park in the very same area ALL of the time so that it will NEVER happen again

Math...I actually had to explain to my Son's 5th grade Teacher that I have a MTBI...geesh...a few months ago he was struggling with Math and I could NOT for the life of me help him... Unfortunately, Math was never a strength of mine lol...though I did very well in pharmacology in Nursing School...that is great advice that you've given me with the checkout girls lol!!!

I find I challenge myself quite a bit on a daily basis...that's my stubborn streak lol!! I'm also terrified of declining cognitively...

I think one of my biggest "gripes" presently is how easily my symptoms can be exacerbated...weather changes, increased activity, stress...sometimes it does, and other times it does not...I never know until I engage myself...it's so variable...I think that is what frustrates me the most...*sigh* but I keep going anyways...and have learned to rest, because I have no choice

I'll look in to the Trolley lines....thanks for your support!!

Hi Julie

Mark's suggestion to try to beat the checkout girls is too ambitious for me at this point in my own recovery. But if you guys can do it - knock yourselves out!

(The stimulation of being in the grocery store with all the people talking, the music overhead and the beeping of the cash register is probably what would most hold me back in that game...)

I have found that playing math games on lumosity has helped my simple math skills a great deal. When I first started playing them in May '10, I couldn't even add or subtract reliably. Before the injury, I had no problems with Math; as a Jr in High School I was learning pre-calculus in Algebra II. Although I never had any trouble with it, I never felt very passionately about it so that was my last real math class because it was the requirement to get into a University at the time. But at work and in my personal life (like trying to calculate 20% of a bill for a tip, or adding the tip to the total) I was using a lot of simple math on a very regular basis, so I was quite concerned that I wasn't able to perform those tasks anymore. I'm still not as good as I was before the injury, but I'm a LOT better than I was in May '10.

So, you might like to try some of the Math games on lumosity for a challenge too. They only have simple math problems: addition, subtraction, multiplication and division.

JulieRN,

If you are lurking about, I just noticed your comment about getting lost. The great thing about the old trolley lines is they are a single trail. Stay on the trail, walk out a few miles, turn around and walk back. The trolley trails are elevated so they are quite obvious. They are also a gravel/cinder base so they do not get real muddy.

Hope you are doing good.

My best to you.